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Become a member and receive career-enhancing benefits
Our top priority is providing value to members. Your Member Services team is here to ensure you maximize your ACS member benefits, participate in College activities, and engage with your ACS colleagues. It's all here.
More than 21,000 US women are expected to receive a diagnosis of ovarian cancer this year, and approximately 12,450 will die from the disease.1
With no recommended screening test for women at average risk, ovarian cancer often is diagnosed after it has advanced, making it one of the deadliest gynecological cancers.
“I hate this disease and what it does to people,” said Rebecca Stone, MD, MS, FACS, the director of gynecologic oncology at Johns Hopkins Medicine in Baltimore, Maryland, who cares exclusively for women with ovarian cancer.
“Ovarian cancer is one of the most common diseases that spread through the abdominal cavity and causes carcinomatosis. As a surgical oncologist with an interest in peritoneal carcinomatosis, I have dealt with ovarian cancer patients for many years,” explained Robert P. Sticca, MD, FACS, Professor Emeritus at the University of North Dakota in Fargo and the Second Vice President of the ACS. “Unfortunately, no matter what we do, once the cancer has started to spread through the abdominal cavity, the prognosis is poor and these unfortunate women suffer tremendously, with the majority eventually succumbing to the disease.”
But in the face of this grim situation, there is an opportunity for prevention—a method that most general surgeons can use to help prevent ovarian tumors from ever developing in most women.
Over time, careful research has shown that many ovarian cancers, especially high-grade serous carcinoma (HGSC), originate in the fallopian tube, particularly the fimbriae, or the tendrils on its flower-shaped distal end.2 This discovery has been important for understanding HGSC, which makes up approximately 75% of ovarian cancers and is the most lethal subtype.
Because the disease originates in this single site, removing the relevant tissue, the fallopian tubes, can greatly reduce lifetime disease risk. Stated another way, opportunistic bilateral salpingectomy (OBS), or removal of both fallopian tubes while a patient is undergoing abdominal or pelvic surgery for an unrelated reason, could substantially reduce ovarian cancer risk at the population level.
Per one study, if OBS was performed by gynecological, general, and other surgeons during many routine abdominal and pelvic operations, it could save as many as 5,800 lives in the US each year.3
Remarkable Degree of Protection
The story of OBS starts with gynecological clinicians and scientists. According to Gillian Hanley, PhD, a researcher with the Ovarian Cancer Research Centre (OVCARE) within the Vancouver Coastal Health Research Institute at the University of British Columbia in Canada, the idea began with then-head (and now associate professor emerita) of the Division of Gynecologic Oncology, Dianne Miller, MD.
Around 2010, Dr. Hanley explained, “Dianne looked through some of our data registry that we have here for ovarian cancer patients, just to see what proportion of patients had previously had a hysterectomy or permanent contraception via tubal ligation. She found that a considerable number of those HGSC patients had previously had one of those two surgeries.”
This finding suggested a cost-effective way to reduce women’s chances of developing ovarian cancer later by using the occasion of their surgery to remove the fallopian tubes, either in addition to a hysterectomy or in place of a tubal ligation.
By the time Dr. Miller hit on this idea, evidence was mounting that many of these cancers began in the fallopian tubes.
Between 2001 and 2007, several researchers examined excised ovarian and fallopian tissue from carriers of BRCA1 and BRCA2 variants.2 They discovered that many had serous tubal intraepithelial carcinoma lesions, the precursors to HGSC, in the fimbriated end of the fallopian tube, “and not on the ovarian surface epithelium, as was previously believed,” Dr. Hanley said.
A combination of the lesions’ small sizes and the complex anatomy of fimbriae had blocked earlier recognition of this site as the origin of ovarian cancer. Understanding the oversight, pathologists launched the Sectioning and Extensively Examining the Fimbria protocol in 2005,4 which has since trained many pathologists to find these lesions. Over time, research into this approach confirmed that many ovarian cancers, particularly HGSC, originate in the fallopian tubes.4
As a result, the idea of fallopian tube removal was understood as a viable option for reducing ovarian cancer risk in women who had completed childbearing. “Dianne had the idea that maybe we could prevent many of these cancers by removing fallopian tubes at the time of hysterectomy, or for people who were looking for tubal permanent contraception,” Dr. Hanley said.
Researchers elsewhere were exploring the same concept. In 2015, Swedish researchers published the first national registry study on ovarian cancer risk after salpingectomy. Their data, collected between 1973 and 2009, included 251,465 women who had undergone sterilization, salpingectomy (unilateral or bilateral), hysterectomy, or hysterectomy with concomitant bilateral salpingo-oophorectomy, and 5.4 million who had had none of these procedures. The study found that bilateral salpingectomy reduced the likelihood of developing ovarian cancer by 65% (hazard ratio, 0.35 [95% CI, 0.17-0.73]).5 (The other procedures also reduced risk by varying amounts.)
Around the same time, OVCARE researchers initiated a population-level study in British Columbia based on electronic health records. They included 25,889 people who had had OBS and 32,080 women who had had a hysterectomy or tubal ligation without salpingectomy between 2008 and 2017.6 At the outset, they calculated the exact number of HGSC cases they expected to find in the OBS group before the study concluded: 5.27.
By the end of the study, they had found zero cases.6
Anatomical image courtesy of Abigail Rumpp at Johns Hopkins Medicine.
This was notable because the population that received OBS differed from the controls in ways that predisposed them to ovarian cancer. Compared with controls, the OBS group had an older mean age, a higher rate of endometriosis, fewer pregnancies, and fewer live births. Researchers confirmed that this group was not less vulnerable to cancer generally, with breast and colorectal cancer (diseases not affected by salpingectomy) seen at the expected rates.6
A second study carried out in British Columbia asked pathologists to submit data when they found cases of ovarian cancer in patients without fallopian tubes. Of the 26 cases found, six were HGSC, or 23.1%, which compared favorably with the 68.1% with this disease in a historical comparison group. This suggested OBS substantially reduced HGSC risk. The same study recalculated the hazard ratio for ovarian cancer in OBS patients versus controls and found it to be 0.22 (95% CI, 0.05-0.95)—a protective factor even stronger than that of the previous Swedish study, which found a hazard ratio of 0.35.7
In sum, these studies established that OBS could provide substantial population-level protection.
OVCARE and other clinicians and researchers have promoted the concept to all surgeons, not just specialists in obstetrics and gynecology. Initially, they suggested that OBS be performed alongside hysterectomies without oophorectomies and in place of tubal ligation.
Today, Dr. Hanley said, there are 24 countries with official recommendations for OBS along these lines, including the US.
“Our major societies in gynecological surgery have come out with guidance…and this has been present for over a decade,” noted Jamie Bakkum-Gamez, MD, FACS, a gynecological surgeon at the Mayo Clinic in Rochester, Minnesota, referring to 2013 guidance from the Society of Gynecologic Oncology8 and a 2019 statement from the American College of Obstetricians and Gynecologists (ACOG)9 and 2026 ACOG Clinical Consensus guidance supporting broader use of salpingectomy for ovarian cancer prevention.10
“In the practice of OB-GYN, this is a pretty accepted standard of care,” said Dr. Bakkum-Gamez.
In fact, she explained, obstetrician-gynecologists have been eager to embrace this procedure: “My own personal experience is leading a study, now years ago, at our own institution. I’ve never had a research project get derailed by so many people changing their practice once they actually saw what the guideline recommendations were. So, we weren’t able to actually do the study, because everybody said, ‘Oh, wow, we should just be doing this.’ So, it’s a very straightforward adaptation and practice change.”
Why Nongynecological Surgeons Should Perform Salpingectomies
Despite this progress, OBS is not yet protecting as many women as it could be.
The reason is simple: it is rarely performed outside of the procedures for which it was first proposed. A study using US data from 2016 to 2020 found that just 735 inpatient bilateral salpingectomies, or 0.05% of the total performed nationwide in that period, occurred during nongynecological surgery.2
This poses a problem because hysterectomies and tubal ligations are declining for several reasons.11 As a result of expanding long-term contraception options, tubal ligations have fallen substantially.12 But even expanding OBS to every hysterectomy and tubal ligation performed would still be insufficient to protect a large segment of the population, as many women never undergo either.
“If you really want to impact the health of women and prevent ovarian cancer, it can’t just be the gynecologists that are performing these procedures,” said Joseph V. Sakran, MD, MPH, MPA, FACS, who is executive vice chair of surgery at Johns Hopkins Medicine in Baltimore, Maryland, and a trauma and general surgeon with training in public health.
In other words, population-level prevention requires that OBS be considered during non-gynecologic abdominal and pelvic procedures.
As Kristin Tischer, MD, an obstetrician-gynecologist at the Mayo Clinic in Rochester, Minnesota, explained about her own research,13 this would open a significantly larger pool of patients: “In our study of 605 patients who ultimately developed HGSC, we found that 56% actually did have a prior surgical opportunity, on average 28 years before their ovarian cancer diagnosis.”
In addition to gynecological surgeons, many surgeons practicing in general, bariatric, colorectal, hepatopancreatobiliary, vascular, and urological surgery could provide OBS to any appropriately selected, consenting patients with no intentions for future childbearing.
“Cholecystectomy seems to be an opportunity. Appendectomy seems to be an opportunity. Patients undergoing colorectal surgery or abdominal hernia repairs—all of those seem to be opportunities in which a surgeon is in that space,” Dr. Bakkum-Gamez said.
“Millions of eligible operations happen in general surgery every year, and we look at those as missed opportunities,” Dr. Sakran said.
Helping Surgeons Perform OBS
Drs. Sakran and Stone are leaders in Outsmart Ovarian Cancer, a national campaign that aims to make OBS standard practice among surgeons operating in the abdomen and pelvis.
Their work stems from the recognition that additional support is needed to help nongynecological surgeons use this technique.
“The gaps are in awareness, training, and areas of reimbursement,” Dr. Sakran said. “We’re trying to raise awareness, we’re trying to make sure people understand their options, and we also want to make sure there’s proper training and informed consent.”
“What I proposed was to take all the implementation tools from OB-GYN that we use to bring this to hysterectomy and permanent contraception and just use them to expand more broadly across the house of surgery. But… there was no pathway forward,” Dr. Stone explained. “There was no billing code for the procedure. There were no CPT codes.”
Recognizing reimbursement as a potential barrier to widespread implementation, Dr. Stone and others at Outsmart Ovarian Cancer have worked to improve coding and insurance coverage for OBS. In October 2025, a dedicated ICD-10-CM code, Z40.82, took effect for prophylactic removal of the fallopian tubes in patients without known genetic or familial risk factors, including opportunistic salpingectomy.
For appropriate reimbursement, an ICD-10-CM code, identifying the reason for the procedure, must be matched with a Current Procedural Terminology (CPT) code specifying the procedure performed. Dr. Stone and colleagues are working to secure one, and to ensure it is used fully: “You have to get that code written into health plans,” she noted.
Her own research has shown only a minority of health plans currently include OBS. As a result, insurance coverage is variable.
Dr. Sticca, who has practiced in North Dakota, explained, “The payment situation is pretty much entirely dependent on your location and the insurance. I know in our state, they will pay for it. In South Dakota, they are in the process. So, it just depends on where you are and what the local and regional insurance payors will cover.”
Outsmart Ovarian Cancer has also contributed to surgeon education. Its website offers educational resources for surgeons, including 2D and 3D images of OBS and self-guided courses. They complement education provided by OVCARE and individual surgeons, such as Dr. Sticca, who has presented on OBS to surgeon audiences.
Likewise, the ACS has mounted educational efforts at Clinical Congress, where Dr. Sakran presented in a Panel Session and press conference on OBS, and Dr. Bakkum-Gamez led a Meet the Experts session in 2025.
Additional research is ongoing. While substantial evidence supports the safety and effectiveness of OBS during gynecologic surgery, additional studies are examining training, feasibility, and safety when it is added to nongynecological procedures. Johns Hopkins and other US healthcare centers are now engaged in a large-scale trial on OBS in nongynecological patients.
Similarly, OVCARE has mounted a clinical trial in British Columbia to engage colorectal surgeons in OBS. Dr. Hanley noted it has yielded an operative success rate of 89%, with all failures related to the presence of pelvic adhesions. OVCARE also has engaged general surgeons and urologists and is now opening a trial of OBS during laparoscopic cholecystectomy.
Dr. Robert Sticca presents on opportunistic bilateral salpingectomy.
Addressing Barriers to Broader Use
Most remaining common questions are straightforward to address.
“Often, when we’re talking to surgeons about starting to do opportunistic salpingectomy, they will wonder if they need to do some kind of complicated risk calculation for their patients,” Dr. Hanley said. “The answer is no. It has nothing to do with that. It really is just about taking advantage of the fact that you’re already doing another surgery in the pelvis or abdomen.”
Similarly, some surgeons wonder if partial removal is worthwhile when full bilateral salpingectomy is impeded. “It’s a dose-response relationship,” Dr. Stone said, explaining that partial removal generates benefit aligned with the percentage of total tissue excised.4 “Even removing one tube—say you can’t get the other one out because of adhesions—we know mathematically from population-level data that you reduce someone’s risk by half as much. But still, it’s better than nothing.”
“Two concerns were expressed in the presentations that I’ve given and by the people I’ve talked to,” Dr. Sticca said. “Number one is privileging at their hospital, because technically this is a gynecologic procedure. But most surgeons who operate in the pelvis have had occasion to take out an ovary for a variety of reasons, and it is considered to be within the spectrum of general surgical procedures. The second concern was, ‘Am I going to make my OB-GYN colleagues mad?’ My advice would be to speak to your OB-GYN colleagues. Most of them are not really concerned and realize the potential benefits of OBS in preventing ovarian cancer.”
Indeed, the new guidance from ACOG acknowledges the importance of “cross-specialty collaboration to expand the availability of salpingectomy”10 to achieve risk reduction and therefore advises a supportive stance, stating, “Obstetrician–gynecologists should support other surgical specialists in offering salpingectomy at the time of non-gynecologic surgery by providing counseling and technical assistance as needed.”10
Dr. Sakran noted that the additional time to complete OBS is brief. It has been measured at 3.5 to 13 minutes,2 depending on details of the surgery it is added to. He also said OBS can easily be done during open, laparoscopic, or robotic procedures: “It doesn’t really make a difference. It’s relatively simple to do either way.”
He noted, however, that OBS belongs in planned operations, not emergencies. “This is never something we add on in the middle of the night or in an emergency case,” he said. “It’s a conversation that happens in clinic, well before surgery.”
The procedure also has been found to be cost-effective. One article pressing for universal insurance coverage calculated savings in the US of up to $445 million annually via the prevention of cancers that require complex oncologic care and shorten lives.14
One final issue is more vexing. Drs. Hanley and Stone noted concerns about patient trust, rooted in traumatic histories of forced sterilization of historically marginalized populations in the US and Canada.
“We want to make sure that we do this in a way that is sensitive to our past and honors surgical safety,” Dr. Stone said, describing appropriate credentialing, performance metrics, and ongoing discussion as critical tools to ensure patient autonomy is respected.
Dr. Sakran added that equity must be built in from the start: “We have to make sure this option isn’t available only to the women who happen to know to ask for it.”
Looking Toward Broader Adoption
That said, all the interviewees for this article are enthusiastic about the potential for OBS to reduce ovarian cancer risk.
“I promised my patients that I would continue to work on this until I myself take my last breath,” Dr. Stone said of her quest to see OBS adopted widely. “This is one of the most important discoveries of our lifetime.”
For Dr. Sticca, OBS raises similarly strong feelings: “I’m very excited about this, because as somebody who’s treated advanced ovarian cancer patients for almost my entire career, it would be very gratifying for me to see this initiative really get popular for actually preventing ovarian cancer, rather than treating it after it’s already diagnosed and much more difficult to cure.”
For others, the drive is about the opportunity to see a powerful tool used for good. Dr. Sakran said, “We now have found a way to outsmart a disease that has eluded us for generations. We have the science, we have the technique, and now we need to make sure that women know the options that exist. That’s why we’ve been doing this work.”
M. Sophia Newman is the Medical Writer and Speechwriter in the ACS Division of Strategic Marketing & Communications in Chicago, IL.
Fisch C, Gelderblom ME, Hermens RPMG, et al. Ovarian cancer risk reduction by salpingectomy during non-gynaecological surgery: Scoping review. BJS Open. 2025;9(1):zrae161.
Cathcart AM, Harrison R, Luccarelli J. Opportunistic salpingectomy during non-gynaecological surgery in the United States: A population-based retrospective study. Br J Surg. 2023;110(9):1215–1217.
Samimi G, Trabert B, Duggan MA, et al. Processing of fallopian tube, ovary, and endometrial surgical pathology specimens: A Survey of U.S. laboratory practices. Gynecol Oncol. 2018;148(3):515–520.
Falconer H, Yin L, Grönberg H, Altman D. Ovarian cancer risk after salpingectomy: A nationwide population-based study. J Natl Cancer Inst. 2015;107(2):dju410.
Hanley GE, Pearce CL, Talhouk A, et al. Outcomes from opportunistic salpingectomy for ovarian cancer prevention. JAMA Netw Open. 2022;5(2):e2147343.
Sowamber R, Mei AJ, Kaur P, et al. Serous ovarian cancer following opportunistic bilateral salpingectomy. JAMA Netw Open. 2026;9(2):e2557267.
American College of Obstetricians & Gynecologists Committee on Clinical Consensus—Gynecology. Salpingectomy for the Prevention of Epithelial Ovarian Cancer. Obstet Gynecol. Published online August 25, 2026.
Simms KT, Yuill S, Killen J, et al. Historical and projected hysterectomy rates in the USA: Implications for future observed cervical cancer rates and evaluating prevention interventions. Gynecol Oncol. 2020;158(3):710-718.
Fang NZ, Westhoff CL. Update on incidence of inpatient tubal ligation and long-acting reversible contraception in the United States. Am J Obstet Gynecol. 2022;227(3):477.e1-477.e7.
Tischer KM, Islam NS, McGree ME, et al. Quantifying opportunities to reduce high grade serous ovarian cancer via opportunistic salpingectomy. Gynecol Oncol. 2025;203:165-170.
Naumann WR, Hughes BN, Brown J, Drury LK, Herzog TJ. The impact of opportunistic salpingectomy on ovarian cancer mortality and healthcare costs: A call for universal insurance coverage. Am J Obstet Gynecol. 2021;225(4):397.e1-397.e6.
